ABN 19 040 349 865
STAMP DUTIES ACT, 1923
STATEMENT
(To be lodged together with completed Opinion Form and Declaration)
Full name and address of person(s), company etc. disposing of property;
Full name and address of person(s), company etc. acquiring property;
Detail fully the nature and effect of the transaction (use attachment if necessary);
The unencumbered market value of any property to which the transaction relates is
$ (evidence of value is required)
The total consideration paid or payable between the parties to the transaction is
$
6. The date of the transaction is
N.B. (a) If a Statement relating to a transaction to which the Section applies is not lodged with the Commissioner within two months after a change in legal or equitable ownership of property each party is guilty of an offence and liable to a fine not exceeding $10,000.
(b) Section 71e subsection (7) provides for persons other than the parties to the transaction to also be guilty of an offence.
(COPY RECEIPT) (CLERK’S DATE STAMP) SUPERIOR COURT OF
(COPY RECEIPT) (CLERK’S DATE STAMP) SUPERIOR COURT OF WASHINGTON
(DA COMPILARSI IN STAMPATELLO O A MACCHINA E INVIARE
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